Provider Demographics
NPI:1154321990
Name:TILLI, FRANK V (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:V
Last Name:TILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7334
Mailing Address - Country:US
Mailing Address - Phone:810-606-7550
Mailing Address - Fax:
Practice Address - Street 1:3452 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7334
Practice Address - Country:US
Practice Address - Phone:810-606-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061859L207RC0000X
MI4301065166207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0086918000Medicaid
MION72340OtherMEDICARE GROUP
PA0016580440010Medicaid
MI0250723OtherBCBS
OH2444091Medicaid
PA000561NJ5Medicare PIN
PAG18044Medicare UPIN
MION72340OtherMEDICARE GROUP
MIN72340066Medicare PIN